Abstracts

Rationale: Perinatal infarcts due to internal carotid artery branch occlusion and watershed infarcts frequently result in seizures. In approximately 10% of these patients, seizures become medically intractable. We report the surgical management of children and adults with medically refractory seizures after ischemic perinatal infarction.Methods: A retrospective review of 5 patients, ages 10 months to 35 years, followed at the Comprehensive Epilepsy Center at Beth Israel Medical Center in New York was performed. Pre and post-operative evaluations included: EEG recordings with video monitoring, MRI, PET scans, and fMRI. All patients were treated with staged operations using invasive monitoring with grid and strip electrodes spaced 7-10 days apart in the majority of cases. Results: Five children (4M, 1F)(18 mos-14 years) and one adult (35,F) were included in this study. Duration of epilepsy ranged from 15 months to 32 years. Two patients had middle cerebral artery branch (MCA) occlusions, 2 patients had posterior cerebral artery occlusions, and two patients had posterior MCA territory watershed infarcts. The surgical procedures included: 2 periinsular functional hemispherotomies; 2 mesial temporal resections combined with a frontal/occipital resections for dual pathology; and two focal cortical resections. All patients are seizure free at follow-up (mean F/U 15.5 mos, range 6 mos-30 mos), and all patients are off AEDs or tapering medicines at last follow-up. There was no major morbidity or mortality in this series.Conclusions: Medically intractable seizures due to perinatal infarction are successfully treated with surgical management. We advocate the use of invasive monitoring where concerns over dual pathology exist, and periinsular functional hemispherotomy as early as possible in patients with major MCA branch occlusions.